A job in an individual’s life and an employee in an employer’s life play a very significant role. And in case an employee is unable to continue a job temporarily or permanently due to injury during work, the individual may find themself stuck in a pit. The financial troubles due to the piling of bills and inability to maintain an income may just become the push needed to fall off a cliff for someone.
The concept of worker’s compensation originated to prevent a helpless scenario like this. In simple terms, this is a small fund maintained or retained back from one’s salary to cushion the impact on their wallet in case an unforeseen accident occurs. To help an employee through the perilous time as such and help then reboot in life once again. Worker’s compensation benefits to the healthy working society have been enough to make the government see through the appropriate implementation of such a system.
Lawfully, if one is injured during the job, they can file a claim for worker’s compensation to get financial help throughout treatment shall their employer opt to provide for it. But as it involves a significant amount most of the time, a worker’s compensation claim is passed through strict scrutiny. And unfortunately, quite a handful of valid worker’s compensation claims get turned down every year due to one or the other miscommunication between the individual and the insurance company.
Workers Compensation Claim Denied
Getting a worker’s compensation denied can be distressing. Medical bills have an old tendency of spiraling out of control easily. Not having a stable income in such time and getting your claim denied is almost the same as getting stuck in quicksand. But there is a good deal of things you can do to come out of this quicksand. The first being the most universal one, don’t panic.
Talk of your employer:
Miscommunication is one of the most common reasons for a denied worker’s compensation. One should first and foremost try to ask their employer about the reasons for the denial of the claim. Providing missing information or clarifying the obscure details solve a lot of worker’s compensation cases.
Request a benefit review conference:
Law in Texas allows one to request a meeting with your employer and Texas Department of Insurance, Worker’s Compensation division to solve the disputed worker’s compensation claim cases.
Taking legal action:
If the other methods fail and you still believe that you’ve been wrong, you can take your case to an experienced local worker’s compensation claim attorney to discuss the future actions available to one.
Understanding Texas’ worker’s compensation laws
Texas worker’s compensation act controls how worker’s compensation claims should be handled. But in the end, it is the choice of the employer if they wish to provide compensation to the employees.
In case the employer provides a worker’s compensation, the following benefits follow:
To employee: Insurance coverage that theoretically covers reasonable and necessary medical bills A percentage of their lost wages, according to the extent of their injury due to accident in the workplace.
To employer: The employee can’t sue them for their involvement in the injury.
Shall an employer not opt to provide worker’s compensation, the protection against being sued by their employee in case of an injury on the job is withdrawn.
Contesting a Denied Claim in Texas
In case even the benefits review conference fails to satisfy one, the law enables one to further contest their case. The unsatisfied individual can choose to take the case for:
Arbitration
A quicker and cheaper option where the case is taken to an arbitrator with all the evidence and arguments of both sides. Once the arbitrator makes the decision, it cannot be appealed again.
Contested Case Hearing(CCH)
Another road one can take instead of arbitration. CCH is similar to a trial but held under a hearing officer of the Division of Worker’s Compensation. Unlike arbitration, a decision made by a hearing officer can still be appealed if unsatisfactory.